Medical Mystery Monday #50: the case of the impotent man (SFW)

Today’s mystery is an interesting disorder that has an even more interesting treatment. Can you guess what it is?

A 38 year old man goes to his primary care physician because he has been unable to get an erection for the past few weeks. He states he has a great marriage and he does not believe it is due to any psychological factors, but he has lost his libido. When his doctor asks him if he has had any other symptoms, the patient response he has been feeling excessively fatigued lately even though he has not had any major changes at work or in his life. He also complains of joint pain in his knuckles, knees, and wrists. The patient’s only medical condition is diabetes since the age of 30, which is fairly well controlled with medication. The patient does not smoke or drink. He has not traveled out of the country recently. He was adopted so his family history is unknown.

On physical exam, the patient’s skin appears tan (he is normally a pale Caucasian man). When the physician asks about it, the patient denies spending any time in the sun. The patient’s liver is enlarged. His joints are not swollen or inflamed. His genitalia appear normal, though his pubic hair is sparse. His nails are oddly shaped (shown below).